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General NPI Number Information
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NPI Number | 1174312854
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Entity Type | Individual
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Provider Name | PAULA VANES PTA
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Gender | Female
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 2 FENWICK RD
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City | HAMPTON
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State | VA
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Zip | 23651-1120
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Country | US
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Telephone | 757-593-0358
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BAXTER ST
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City | HAMPTON
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State | VA
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Zip | 23669-1625
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Country | US
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Telephone | 757-870-1974
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306601385
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License Number State | VA
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